{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,6]],"date-time":"2026-11-06T07:50:33Z","timestamp":1793951433083,"version":"4.8.0"},"reference-count":39,"publisher":"BMJ","issue":"e1","license":[{"start":{"date-parts":[[2021,3,4]],"date-time":"2021-03-04T00:00:00Z","timestamp":1614816000000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"DOI":"10.13039\/100012297","name":"Society of Family Planning","doi-asserted-by":"publisher","award":["SFPRF11-II1"],"award-info":[{"award-number":["SFPRF11-II1"]}],"id":[{"id":"10.13039\/100012297","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Sex Reprod Health"],"accepted":{"date-parts":[[2021,2,15]]},"published-print":{"date-parts":[[2022,1]]},"abstract":"<jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>Transgender, nonbinary and gender-expansive (TGE) people face barriers to abortion care and may consider abortion without clinical supervision.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>In 2019, we recruited participants for an online survey about sexual and reproductive health. Eligible participants were TGE people assigned female or intersex at birth, 18 years and older, from across the United States, and recruited through The PRIDE Study or via online and in-person postings.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>Of 1694 TGE participants, 76 people (36% of those ever pregnant) reported <jats:italic>considering<\/jats:italic> trying to end a pregnancy on their own without clinical supervision, and a subset of these (n=40; 19% of those ever pregnant) reported <jats:italic>attempting<\/jats:italic> to do so. Methods fell into four broad categories: herbs (n=15, 38%), physical trauma (n=10, 25%), vitamin C (n=8, 20%) and substance use (n=7, 18%). Reasons given for abortion without clinical supervision ranged from perceived efficiency and desire for privacy, to structural issues including a lack of health insurance coverage, legal restrictions, denials of or mistreatment within clinical care, and cost.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>These data highlight a high proportion of sampled TGE people who have attempted abortion without clinical supervision. This could reflect formidable barriers to facility-based abortion care as well as a strong desire for privacy and autonomy in the abortion process. Efforts are needed to connect TGE people with information on safe and effective methods of self-managed abortion and to dismantle barriers to clinical abortion care so that TGE people may freely choose a safe, effective abortion in either setting.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1136\/bmjsrh-2020-200966","type":"journal-article","created":{"date-parts":[[2021,3,5]],"date-time":"2021-03-05T14:32:59Z","timestamp":1614954779000},"page":"e22-e30","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":48,"title":["Abortion attempts without clinical supervision among transgender, nonbinary and gender-expansive people in the United States"],"prefix":"10.1136","volume":"48","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2488-2429","authenticated-orcid":false,"given":"Heidi","family":"Moseson","sequence":"first","affiliation":[{"name":"Ibis Reproductive Health, Oakland, California, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5655-086X","authenticated-orcid":false,"given":"Laura","family":"Fix","sequence":"additional","affiliation":[{"name":"Ibis Reproductive Health, Cambridge, Massachusetts, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2488-5072","authenticated-orcid":false,"given":"Caitlin","family":"Gerdts","sequence":"additional","affiliation":[{"name":"Ibis Reproductive Health, Oakland, California, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sachiko","family":"Ragosta","sequence":"additional","affiliation":[{"name":"Ibis Reproductive Health, Oakland, California, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jen","family":"Hastings","sequence":"additional","affiliation":[{"name":"Department of Family and Community Medicine, University of California San Francisco, San Francisco, California, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ari","family":"Stoeffler","sequence":"additional","affiliation":[{"name":"Ibis Reproductive Health, Cambridge, Massachusetts, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eli A","family":"Goldberg","sequence":"additional","affiliation":[{"name":"Department of Family Medicine, The Robert Larner, M.D. College of Medicine at the University of Vermont, Burlington, Vermont, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mitchell R","family":"Lunn","sequence":"additional","affiliation":[{"name":"Department of Nephrology, Stanford University School of Medicine, Stanford, California, USA"},{"name":"Department of Epidemiology and Population Health, Stanford University School of Medicine, Stanford, CA, USA"},{"name":"The PRIDE Study, Stanford University, Stanford, California, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Annesa","family":"Flentje","sequence":"additional","affiliation":[{"name":"The PRIDE Study, Stanford University, Stanford, California, USA"},{"name":"Department of Community Health Systems, University of California San Francisco, San Francisco, California, USA"},{"name":"Alliance Health Project, Department of Psychiatry, University of California, San Francisco, San Francisco, CA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matthew R","family":"Capriotti","sequence":"additional","affiliation":[{"name":"The PRIDE Study, Stanford University, Stanford, California, USA"},{"name":"Department of Psychology, San Jose State University, San Jose, California, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Micah E","family":"Lubensky","sequence":"additional","affiliation":[{"name":"The PRIDE Study, Stanford University, Stanford, California, USA"},{"name":"Department of Community Health Systems, University of California San Francisco, San Francisco, California, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Juno","family":"Obedin-Maliver","sequence":"additional","affiliation":[{"name":"Department of Epidemiology and Population Health, Stanford University School of Medicine, Stanford, CA, USA"},{"name":"The PRIDE Study, Stanford University, Stanford, California, USA"},{"name":"Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, California, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2021,3,4]]},"reference":[{"key":"2025090221355024000_48.e1.e22.1","doi-asserted-by":"crossref","first-page":"266","DOI":"10.1016\/j.contraception.2018.06.006","article-title":"Family planning and contraception use in transgender men","volume":"98","author":"Light","year":"2018","journal-title":"Contraception"},{"key":"2025090221355024000_48.e1.e22.2","article-title":"Abortion experiences and preferences of transgender, nonbinary, and gender-expansive people in the United States","author":"Moseson","year":"2020","journal-title":"Am J Obstet Gynecol"},{"key":"2025090221355024000_48.e1.e22.3","unstructured":"Flores AR , Herman JL , Gates GJ . How many adults identify as transgender in the United States? Los Angeles, CA: The Williams Institute, 2016."},{"key":"2025090221355024000_48.e1.e22.4","doi-asserted-by":"publisher","DOI":"10.2105\/AJPH.2017.303882"},{"key":"2025090221355024000_48.e1.e22.5","doi-asserted-by":"crossref","first-page":"156","DOI":"10.1089\/trgh.2017.0028","article-title":"Factors associated with gender-affirming surgery and age of hormone therapy initiation among transgender adults","volume":"2","author":"Beckwith","year":"2017","journal-title":"Transgend Health"},{"key":"2025090221355024000_48.e1.e22.6","doi-asserted-by":"crossref","first-page":"418","DOI":"10.1016\/j.jpurol.2016.09.015","article-title":"Fertility in disorders of sex development: a review","volume":"12","author":"Van Batavia","year":"2016","journal-title":"J Pediatr Urol"},{"key":"2025090221355024000_48.e1.e22.7","doi-asserted-by":"crossref","first-page":"58","DOI":"10.1080\/13625187.2017.1422240","article-title":"Preserving the reproductive potential of transgender and intersex people","volume":"23","author":"Rowlands","year":"2018","journal-title":"Eur J Contracept Reprod Health Care"},{"key":"2025090221355024000_48.e1.e22.8","doi-asserted-by":"publisher","DOI":"10.1089\/apc.2010.0059"},{"key":"2025090221355024000_48.e1.e22.9","doi-asserted-by":"publisher","DOI":"10.1080\/15532739.2013.791650"},{"key":"2025090221355024000_48.e1.e22.10","doi-asserted-by":"crossref","unstructured":"Fix L , Durden M , Obedin-Maliver J . Stakeholder perceptions and experiences regarding access to contraception and abortion for transgender, non-binary, and gender-expansive individuals assigned female at birth in the U.S.. Arch Sex Behav 2020.","DOI":"10.1007\/s10508-020-01707-w"},{"key":"2025090221355024000_48.e1.e22.11","doi-asserted-by":"crossref","first-page":"1059","DOI":"10.1097\/AOG.0000000000003816","article-title":"The imperative for transgender and gender nonbinary inclusion: beyond women's health","volume":"135","author":"Moseson","year":"2020","journal-title":"Obstet Gynecol"},{"key":"2025090221355024000_48.e1.e22.12","doi-asserted-by":"publisher","DOI":"10.2105\/AJPH.2013.301378"},{"key":"2025090221355024000_48.e1.e22.13","doi-asserted-by":"publisher","DOI":"10.1016\/j.whi.2013.03.001"},{"key":"2025090221355024000_48.e1.e22.14","doi-asserted-by":"crossref","first-page":"58","DOI":"10.1089\/trgh.2018.0022","article-title":"Motivators and barriers to accessing sexual health care services for transgender\/genderqueer individuals assigned female sex at birth","volume":"4","author":"Harb","year":"2019","journal-title":"Transgend Health"},{"key":"2025090221355024000_48.e1.e22.15","doi-asserted-by":"crossref","first-page":"136","DOI":"10.1016\/S0968-8080(10)36534-7","article-title":"Self-induction of abortion among women in the United States","volume":"18","author":"Grossman","year":"2010","journal-title":"Reprod Health Matters"},{"key":"2025090221355024000_48.e1.e22.16","doi-asserted-by":"crossref","first-page":"91","DOI":"10.1016\/j.contraception.2020.04.015","article-title":"Effectiveness of self-managed medication abortion between 13 and 24 weeks gestation: a retrospective review of case records from accompaniment groups in Argentina, Chile, and Ecuador","volume":"102","author":"Moseson","year":"2020","journal-title":"Contraception"},{"key":"2025090221355024000_48.e1.e22.17","doi-asserted-by":"crossref","DOI":"10.1186\/s12905-019-0877-0","article-title":"Texas women's decisions and experiences regarding self-managed abortion","volume":"20","author":"Fuentes","year":"2020","journal-title":"BMC Womens Health"},{"key":"2025090221355024000_48.e1.e22.18","doi-asserted-by":"crossref","first-page":"87-110","DOI":"10.1016\/j.bpobgyn.2019.08.002","article-title":"Self-managed abortion: a systematic scoping review","volume":"63","author":"Moseson","year":"2020","journal-title":"Best Pract Res Clin Obstet Gynaecol"},{"key":"2025090221355024000_48.e1.e22.19","doi-asserted-by":"crossref","first-page":"242","DOI":"10.1016\/j.contraception.2017.06.006","article-title":"Community-based distribution of misoprostol for early abortion: evaluation of a program along the Thailand-Burma border","volume":"96","author":"Foster","year":"2017","journal-title":"Contraception"},{"key":"2025090221355024000_48.e1.e22.20","doi-asserted-by":"crossref","DOI":"10.1186\/s12978-020-01016-4","article-title":"Self-managed medication abortion outcomes: results from a prospective pilot study","volume":"17","author":"Moseson","year":"2020","journal-title":"Reprod Health"},{"key":"2025090221355024000_48.e1.e22.21","doi-asserted-by":"crossref","DOI":"10.1136\/bmjopen-2019-034670","article-title":"Women's self-reported experiences using misoprostol obtained from drug sellers: a prospective cohort study in Lagos State, Nigeria","volume":"10","author":"Stillman","year":"2020","journal-title":"BMJ Open"},{"key":"2025090221355024000_48.e1.e22.22","doi-asserted-by":"publisher","DOI":"10.1136\/bmjsrh-2018-200102"},{"key":"2025090221355024000_48.e1.e22.23","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.j2011"},{"key":"2025090221355024000_48.e1.e22.24","doi-asserted-by":"publisher","DOI":"10.1363\/psrh.12073"},{"key":"2025090221355024000_48.e1.e22.25","doi-asserted-by":"crossref","first-page":"23.e1","DOI":"10.1016\/j.ajog.2010.08.019","article-title":"How commonly do US abortion patients report attempts to self-induce?","volume":"204","author":"Jones","year":"2011","journal-title":"Am J Obstet Gynecol"},{"key":"2025090221355024000_48.e1.e22.26","doi-asserted-by":"crossref","DOI":"10.1186\/s12905-019-0812-4","article-title":"Reducing underreporting of stigmatized pregnancy outcomes: results from a mixed-methods study of self-managed abortion in Texas using the list-experiment method","volume":"19","author":"Moseson","year":"2019","journal-title":"BMC Womens Health"},{"key":"2025090221355024000_48.e1.e22.27","doi-asserted-by":"crossref","DOI":"10.1001\/jamanetworkopen.2020.29245","article-title":"Prevalence of self-managed abortion among women of reproductive age in the United States","volume":"3","author":"Ralph","year":"2020","journal-title":"JAMA Netw Open"},{"key":"2025090221355024000_48.e1.e22.28","doi-asserted-by":"publisher","DOI":"10.1363\/psrh.12151"},{"key":"2025090221355024000_48.e1.e22.29","first-page":"1","article-title":"Pregnancy intentions and outcomes among transgender, nonbinary, and gender-expansive people assigned female or intersex at birth in the United States: results from a national, quantitative survey","volume":"133","author":"Moseson","year":"2020","journal-title":"Int J Transgend Health"},{"key":"2025090221355024000_48.e1.e22.30","doi-asserted-by":"crossref","DOI":"10.1016\/j.conx.2020.100019","article-title":"Transgender abortion patients and the provision of transgender-specific care at non-hospital facilities that provide abortions","volume":"2","author":"Jones","year":"2020","journal-title":"Contracept X"},{"key":"2025090221355024000_48.e1.e22.31","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0216282","article-title":"Using mobile technology to engage sexual and gender minorities in clinical research","volume":"14","author":"Lunn","year":"2019","journal-title":"PLoS One"},{"key":"2025090221355024000_48.e1.e22.32","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0232154","article-title":"Development of an affirming and customizable electronic survey of sexual and reproductive health experiences for transgender and gender nonbinary people","volume":"15","author":"Moseson","year":"2020","journal-title":"PLoS One"},{"key":"2025090221355024000_48.e1.e22.33","unstructured":"World Health Organization (WHO) . Medical management of abortion, 2018. Available: https:\/\/apps.who.int\/iris\/bitstream\/handle\/10665\/278968\/9789241550406-eng.pdf?ua=1"},{"key":"2025090221355024000_48.e1.e22.34","doi-asserted-by":"publisher","DOI":"10.2105\/AJPH.2013.301339"},{"key":"2025090221355024000_48.e1.e22.35","doi-asserted-by":"crossref","first-page":"109","DOI":"10.1089\/jwh.2015.1518","article-title":"Time for OBGYNs to care for people of all genders","volume":"24","author":"Obedin-Maliver","year":"2015","journal-title":"J Womens Health"},{"key":"2025090221355024000_48.e1.e22.36","doi-asserted-by":"crossref","first-page":"47","DOI":"10.1089\/trgh.2017.0048","article-title":"Attitudes, and beliefs when caring for transgender people","volume":"3","author":"Paradiso","year":"2018","journal-title":"Transgender health"},{"key":"2025090221355024000_48.e1.e22.37","doi-asserted-by":"publisher","DOI":"10.1080\/10401334.2015.1044656"},{"key":"2025090221355024000_48.e1.e22.38","doi-asserted-by":"crossref","DOI":"10.1111\/1471-0528.16668","article-title":"Effectiveness, safety and acceptability of no-test medical abortion provided via telemedicine: a national cohort study","author":"Aiken","year":"2021","journal-title":"BJOG"},{"key":"2025090221355024000_48.e1.e22.39","unstructured":"Legal L . Intersex 101, 2015. Available: https:\/\/www.lambdalegal.org\/blog\/20151026_intersex-101"}],"container-title":["BMJ Sexual &amp; Reproductive Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bmjsrh-2020-200966","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,9,3]],"date-time":"2025-09-03T04:36:01Z","timestamp":1756874161000},"score":1,"resource":{"primary":{"URL":"https:\/\/jfprhc.bmj.com\/lookup\/doi\/10.1136\/bmjsrh-2020-200966"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,3,4]]},"references-count":39,"journal-issue":{"issue":"e1","published-online":{"date-parts":[[2021,12,17]]},"published-print":{"date-parts":[[2022,1]]}},"alternative-id":["10.1136\/bmjsrh-2020-200966"],"URL":"https:\/\/doi.org\/10.1136\/bmjsrh-2020-200966","relation":{},"ISSN":["2515-1991","2515-2009"],"issn-type":[{"value":"2515-1991","type":"print"},{"value":"2515-2009","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,3,4]]}}}